This article is devoted to such a structure as a hospice. What it is, many know only approximately: most ordinary people - by accidentally reading or hearing something somewhere, doctors - from the experience of American or European colleagues, and journalists - from various sources.

This situation is not accidental and is caused by an incorrect understanding of the tasks solved by hospice institutions. When and how did the first hospices emerge? What goals and objectives do they solve? What is children's hospice? We will try to answer all these questions in detail.

Why are they needed?

Quite often the concept of “hospice” is associated with isolation and a place where one’s own last days Seriously ill and dying people live far from the rest of the world. However, this is not true. The symbol of the hospice is a candle going out in human hands. It is this symbol that helps to reveal the essence of the care provided to seriously ill patients and to clearly explain: hospice - what it is. In such clinics, they treat sick and dying people with care and reverence, show compassion and, empathizing, provide them with decent care and pain relief, help them overcome spiritual, physiological and psychological problems caused by illness.

What does this word mean?

Initially, the word “hospice” arose in Latin from the merger of two roots - hospitium and hospes - “hospitality”. Subsequently, the word passed into Old French as hospice and retained the same meaning as it had in Latin. In the Middle Ages, this was the name given to houses where travelers stopped to rest during a pilgrimage to Jerusalem. During long journeys, the pilgrims got sick, and in such hospices they were provided with all possible medical care. Together with the pilgrims, the word “hospice” came to the British Isles and English language, from where it passed into other European languages ​​in the 19th century.

History of appearance

Hippocrates, considered the “father of medicine,” believed that doctors should help only those who have a chance of recovery, and hopeless patients should live out their lives without care or attention. A similar approach to the dying was practiced in Europe until the widespread spread of Christianity.

In the French city of Lyon in 1842, the first hospice was organized by Jeanne Garnier, a young woman who had lost her entire family. What was it like at that time? The Golgotha ​​Hospice, as it was called, for the first time provided the opportunity for terminally ill patients to live and die with dignity. Irish nuns supported Jeanne Garnier's idea and opened the Mother of God Hospice in Dublin in 1879. In 1948, Cecilia Sanders came to work at St. Thomas' Hospital in London, thanks to whose work the hospice movement spread throughout the world. Moscow hospices that operate today were also opened.

Modern history

Enough long time neither doctors, nor nursing staff, nor volunteers knew what it should be like proper care for hospice patients, and there was nowhere to get such information. Only in 1935 was it published, which later became a classic of palliative medicine, written by family doctor Alfred Worchester pamphlet "Care for the Sick and Dying." Targeted training of nurses to work with incurable and dying patients began to be carried out by employees of the Marie Curie Foundation only in 1952.

In 1967, St. Christopher's Hospice, founded by Cecilia Sanders, opened its inpatient hospital in England, and since 1969 began providing outreach services. In the same year, the book “On Death and Dying” by Elisabeth Kübler-Ross was published, which managed to revolutionize the ideas of doctors of that time about the conditions of a dying person.

Among socialist countries, only in Krakow, Poland, the first hospice appeared in 1972.

Hospices in pre-revolutionary Russia

The first such medical institution was opened in Moscow in 1903. Its creation was initiated by Moscow State University professor and practicing oncologist L.L. Levshin, who organized the collection of funds for its construction. The greatest financial contribution to its organization was made by the famous Russian philanthropists Morozovs. That is why this establishment bore their name for many years. This oncology hospice accepted only cancer patients at the last, terminal stage of development of this disease. However, over time, it lost its functions and was reborn into a research institute dealing with oncology problems.

What about today?

Up to 1990 soviet people They didn’t know about hospice, what it was and why it was needed. Seriously ill people died at home, in the arms of relatives who did not know how to alleviate their suffering, or in hospital beds, almost forgotten medical personnel. The first hospice in modern Russia was opened in the village of Lakhty near St. Petersburg in 1990 on the initiative of the English journalist V. Zorza, who thus fulfilled the dying wish of his daughter Jane, who died at the age of 25. Psychiatrist A.V. Gnezdilov took a great part in this, so that the hospice opened and began its work in the city of St. Petersburg.

In the early 90s of the 20th century, a special Board of Trustees for the creation of hospices was created in the Soviet Union, the chairman of which was Academician D. S. Likhachev. In October 1993 in Moscow, on the initiative of E.I. Moiseenko, who worked at the Institute of Children's Oncology and Hematology, created the first home-based children's hospice for children with cancer.

In 1994, thanks to the efforts of V. Zorza, the First Moscow Hospice, now headed by V. V. Millionshchikova, was created.

How many are there?

Today we have approximately one hundred hospices, which is very small for such a big country like Russia. According to WHO calculations, there should be one hospice for every 400,000 people in the population. That is, if you count, our country lacks at least 250 of these medical institutions. Those that exist do not always meet the requirements and standards. The hospices in Moscow and St. Petersburg are the best equipped, and their number in these cities practically corresponds to WHO calculations. For villagers and those living in the provinces, it is difficult, almost impossible, to get into such an institution.

A terminally ill child... This tragedy can happen in the life of each of us, and then main question: where to look for support when there is no more hope. The motto of the children's hospice “House with a Lighthouse” is “ It's not about death, it's about life" The hospice cares for children with incurable diseases, and it was their stories that formed the basis of the special project “Time to Live” on “D” o Let's wave." Premiere: April 8.

Mothers are often told by friends and doctors that they can’t cope alone when their dads leave them. Children are not accepted into kindergartens and schools, offering to “give birth to a second child.” And the worst thing is that young patients are not provided with qualified medical care, doctors give up on them and do nothing while the child suffers from pain. “Home” will talk about hospice patients and their mothers, about doctors and people who devote themselves to helping children, and will also try to destroy myths about incurable diseases and how you can live with them.

Myth one " You can't do it alone»

According to statistics, a third of fathers leave families with a disabled child and no longer participate in their lives. Young mother Daria Guseva has been raising Sashenka for three years. The child suffocated during childbirth and now lives with the diagnosis ischemic lesion CNS. The girl does not see, does not hear, does not move, but lives and breathes with the help of a tracheostomy and an oxygen concentrator. The father abandoned the family as soon as he learned about his daughter’s diagnosis and Daria’s decision not to send the child to a boarding school. But the mother says she is happy to be able to give her child the best.

Myth two " Incurable children do not need to be taught»

Of the 198 preschoolers cared for by the House with a Lighthouse Children's Hospice, kindergarten Now only 24 children are attending. Only 50 out of 155 schoolchildren are studying. One young man out of several dozen managed to enter the university. In our country they don’t understand why a terminally ill child needs to study, but hospice children dream of going to school. Artem Komarov is nine years old, but he is in second grade. He has congenital muscular dystrophy - the boy cannot even sit on his own, his arms are very weak. But in an electric wheelchair purchased by the hospice, he goes to an ordinary school in the city of Dubna in the Moscow region, whose director wanted to take the boy, despite a lot of problems with installing lifts and ramps. The hospice workers helped Artem make his dream come true and were able to negotiate with the school, which accepted Artem, despite his diagnosis.

Myth three " If you can’t cure it, it means you can’t help it»

Little Fedya Raspopov died quietly in an orphanage. His medical history included a huge number of diagnoses and the staff did not understand how to care for him. Once upon a time in orphanage invited a hospice field service to train nannies. So it began amazing story. Successful businesswoman Tatyana Konova responded to a hospice ad on Facebook to bring Fedya a toy. She fell in love and took him in and became a foster mother. Unfortunately, the boy cannot be cured. But how striking is the contrast between his life in the orphanage without special care- and at home, with my mother, with the support of the hospice.

Myth Four " Hospice is when nothing can be done»

Thirteen-year-old, smiling, tall and handsome Maxim Bezugly was playing football with his friends. A jump, another, hung on the gate - they swayed under the weight and fell. The top bar struck the head, breaking the bones of the skull. Doctors said that the injury was not compatible with life, that he would always be on a ventilator. The tragedy divided everything into “before” and “after”. There was a lot, but now Maxim is home. Breathes and eats on its own. Every day his parents do something that makes Max feel better.

The chief doctor of the hospice, Natalya Savva, talks about how quality care prolongs the lives of children and brings joy back to them.

Myth fifth " If death is inevitable, nothing can be done»

In December 2016, mother Elena buried her daughter Pelageya, who was under the care of a hospice. She had a congenital genetic disease, she lived for nine months in hospitals and intensive care units. The girl's heart stopped. Now Elena admits that during these 9 months only hospice workers were with her. They helped her accept the inevitable.

Life is always stronger than death, even if the smallest and most defenseless are standing at the line. "Home" is sure: even if there is almost no strength and faith left - “Time to live”!

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- Vera Vasilyevna, is your hospice the first in Russia?

No, the first Russian hospice was founded in 1990 in Lakhta, a district of St. Petersburg.

- Did the first hospice appear in the world?..

In England. Baroness Cecilia Sanders, already in adulthood, came to work at the hospital, where she came face to face with the problem of cancer patients. The suffering of one of the patients touched her so deeply that she took up this problem seriously and organized a hospice in 1967. (Today Baroness Sanders is 88 or 89 years old, she still teaches and brings the idea of ​​hospices to the world). Then hospices appeared in America and other countries. And when perestroika began, the Englishman Victor Zorza came to Russia with the idea of ​​hospices.

I think in 1989, the magazine “October” published his and his wife Rosemary’s story “I’m Dying Happy” with a foreword by Dmitry Sergeevich Likhachev?

Yes, this was an excerpt from a book that came out a little later. Victor was a native of Russia, a Ukrainian Jew. In 1971, his daughter Jane contracted melanoma and died in a hospice a year later, at age 26. Having learned before his death that her father was from our country (he hid this all his life), she bequeathed to him the construction of hospices in India and Russia. When the opportunity arose, he carried out her will.

- How did you come to the hospice? After all, if I’m not mistaken, your specialty is not an oncologist, but a gynecologist?

I really started my medical practice in obstetrics - first as a gynecologist, then as an anesthesiologist, but in 1983 she came to oncology.

- While working on birth, did you become interested in the problem of death?

Everything was much more prosaic. I switched to oncology so I could retire early. But the person assumes...

Faced with hopeless cancer patients, I realized that I couldn’t leave them. After all, the state abandoned them to their fate. If the diagnosis was hopeless, the patient was discharged with the wording “to be treated at the place of residence,” that is, not to be treated at all. In principle, these patients are of no interest to doctors. Doctors are determined to win. According to them, it is worth treating a person only for the sake of recovery. It is indecent to even think about death.

- The fruits of an atheistic upbringing?

Certainly. Death has always been hushed up. According to statistics, even in our oncology clinics mortality rate 0.2%. Absurd! For the sake of these false statistics, hopeless patients were “thrown out” home. Only hospices can help these people.

But still not knowing anything about hospices, I myself went to see my former patients, tried to help them until my last breath. Naturally, I did this in my free time from my main job, and I was very tired. In 1991, she got ready to retire, but providentially met Victor. I still work this way and I’m unlikely to ever leave.

- When did your hospice open?

Field service - in May 1994, inpatient service - in 1997.

- Did the state help?

Only the state. The hospice was built with money from the Moscow Government with the participation of the Moscow Health Department.

- For several years your hospice was the only one in Moscow?

Yes, for 8 years we were the only ones. But today there are already four of them, and one of these days we will open a fifth one - in the Southern District. In the near future, there will be hospices in every administrative district of the capital. We serve the Central District.

- Probably, new hospices today need sponsors more?

Of course, but they still need to develop a reputation. The first 4 years were also very difficult for us.

- How many people live in your hospice?

We still have an outreach service that currently serves 130 patients. There are 30 people living in the hospital.

- But can you take more?

No, we can't. We have 30 beds. The hospice environment should be close to home, and this cannot be done with more stationary places.

- Then, apparently, no more than five people live in your wards?

We have single and four-bed rooms. This best option. Some people prefer to live their illness alone (usually children and young people), and, naturally, we place them in a separate ward. Older people, on the contrary, are more likely to seek communication. To avoid psychological incompatibility or, on the contrary, excessive attachment of neighbors to each other (when the death of one can traumatize the other so much that it will shorten his life), not two - and not three -, but four-bed wards are needed.

- Do you help dying people live active, meaningful lives to the end?

You exaggerate the capabilities of a dying person. These people are mainly focused on internal experiences. We have a good library, one artist teaches people to draw for free, and the hospice regularly hosts concerts. We try to give patients positive emotions, but only at their request. Nothing can be imposed on a person, especially a hopelessly ill person.

- In such a state, moments of despair are inevitable. Were there cases when patients demanded euthanasia?

It was not and could not be. Euthanasia does not fit into Russian thinking.

Does not fit, however recent years Many publicists talk about the humanity of euthanasia. They cannot help but know that euthanasia was used in Hitler’s Germany, and yet they still advocate for it without blushing.

Means mass media can do anything. They can zombify people so that they become supporters of euthanasia. But only theoretically. When this problem affects someone personally, no one will want to be “helped” to die. This is contrary to human nature. The thirst for life is the strongest human instinct. I'm not even talking about the ethical side. A person is not the master of his life.

- Vera Vasilievna, does the Church participate in the work of the hospice?

We have a home chapel Life-Giving Trinity. On Tuesdays and Thursdays, Father Christopher Hill from St. Andrew's Monastery serves there.

- How often do you remember non-believers coming to God during illness?

There were such cases, but not often.

- Maybe we need to be more active in missionary work?

It’s impossible, we are not a religious institution. Upon admission, we inform all patients that there is a chapel and on such and such days a priest comes. But Father Christopher will not talk to the patient against his will.

- How many people work at the hospice?

82 people, including accounting, kitchen and laundry.

- You once said in one program that you have a lot of young people in unskilled jobs.

We mainly employ young people. This is due to my interest in young people, with the desire to teach them goodness.

- Do they come for religious reasons?

In different ways. But when hiring, I never ask people if they are believers.

But you're probably asking why they want to work in a hospice, and some say it's because they want to serve God?

Happens. Then I set a condition: not to preach, but to help. Serve the pain, serve the grief.

- But this is serving God.

Certainly. But some believers who came to us sought to read prayers over the sick, not even asking whether they were baptized, and this often frightened non-believers. Father Christopher doesn’t force anything on anyone, but it happened more than once that he came to talk with one patient, and by the end of the conversation, another patient from the same ward, who half an hour earlier had not even thought about communicating with a priest, expressed a desire to talk with him. You can’t impose faith, especially dependent person. And our patients are always dependent on those who help them.

- Vera Vasilievna, over the years of working as a doctor, has your attitude towards death changed?

Drastically. Before, I didn’t think about death at all; either because of youth, or because of vanity. And now... First of all, my attitude towards life has changed. When you are constantly faced with death at work, life becomes more contemplative. In the morning you wake up - thank God, the day has passed, you go to bed, thank God too.

- Why did hospices appear only inXX century? Has the number of cancer diseases increased significantly?

It's not about the increase in diseases, but about the development of medicine. Doctors have learned to diagnose diseases more early stage. In general, hospices are a product of civilization. Civilization leads to a breakdown in relations between people, including between close relatives. Hospices are a result of this gap. Of course, in poor countries this is compounded by the non-intervention of the state in helping the suffering.

In the West, a hospice is a house of death. In England, for example, a patient is placed in a hospice 6 days before death. They put them to die because people don’t want to see death at home. They have a man-made attitude towards death. A relative dies - quickly go to a hospice, then rather be cremated and “continue to live.”

It's different with us. Many people come to us at an early stage, then are discharged; after an indefinite period of time, some come to us again. The first commandment of our hospice (there are 16 in total) says: “A hospice is not a house of death. This decent life until the end. We work with real people. Only they die before us.”

- That is, hospices, although they came to us from the West, in Russia acquired a completely different meaning?

Of course, these are Russian hospices. You cannot graft a foreign model anywhere. The British suggested that we go to them to study, but I said: “No, dears, come to us, study with us. We have different soil, different people, different medicines.” Subsequently, they were grateful to us, although they had to go back 50-60 years ago - they knew about the green stuff only from the stories of their parents.

True, in such megacities as Moscow and St. Petersburg, one can also find a Western attitude of people towards a hospice as a house of death. Our commandments include working with relatives, and we make every effort to improve and change their relationships when necessary. It happens that dad dies, and my daughter has no time to visit him - she has courses. We don’t tell the girl directly, but the meaning is: “What courses? Do you have one dad? So sit with him, look after him, take his hand and say: “Dad, I love you!” (when was the last time I spoke?).” There is a lot more warmth in our hospices. Human warmth. This is the specificity of Russian hospices.

- Should a hospice transform the patient’s relatives?

I think I should. After all, no one knows who is being tested by a serious illness - the patient himself or his relatives? It often happens that the suffering of one person changes better side another. For example, fatal disease The mother not only forced her son to visit her more often, but also opened his eyes to his dissolute life. Therefore, we work with relatives not only to help them overcome grief, but often also to return them to their parents, to remind them that even they, young people, will not last forever.

- Do young hospice employees change their value system in the process of work?

Very fast.

- Do you often have to part with people because they can’t cope with their work?

Often. For the first 60 hours, newcomers work with us for free (we only feed them lunch and give them money for travel), so random people We do not hire. But working in a hospice is hard, exhausting work. It often turns out to be beyond the capabilities of very good young men and women who, in my opinion, can work wonderfully in any other institution. So we part with them not because of them human qualities, but because this cross is beyond their strength. But even those who are capable of it last no more than two years with us. And we have no right either to hold people back or to be offended by them - human strength is limited. I am grateful to everyone who worked for us over these years. And I am very glad that 12 weddings took place between the hospice employees.

- But do doctors work longer?

We have very few doctors: 2 oncologists, a therapist and a gerontologist.

- Is four doctors really enough for a hospice?

Not enough at all. Doctors do not want to work in a hospice; they are not interested here. I told you that the doctors are only determined to win.

- Is this the right attitude?

No. But how do you tell a modern medical student that he will not cure people, but only treat symptoms? This requires a special state of mind. Among our doctors one is very old man, the rest were brought here by their life's ups and downs, they found themselves in a hospice. This is an individual path. Nowadays in medical institutes A bioethics course has emerged that addresses these issues.

Do you think that a bioethics course can change the psychology of students, or will a deeper understanding of life come only with age?

Probably nothing can replace life experience. But without a course in bioethics, this experience can last for for many years and be more tragic.

- In terms of spirituality, does our medical education leave much to be desired?

It is completely unspiritual. Bioethics courses - the first shoots. If they get stronger, something will change. In the meantime, young doctors often have no ideals.

But a doctor is not a profession, but a vocation; his work is not work, but service. Serving God. And the future of Russia depends not least on the spirituality of doctors?

I don’t dare predict about the future of Russia, but the future of our medicine seems gloomy to me. I'd like to be wrong.

- Vera Vasilyevna, how many hospices are open in Russia today?

About fifty.

- In cities?

Mostly. But there are also in villages. One near Yaroslavl (and in Yaroslavl itself there are two more hospices) and one in Bashkiria.

- How satisfied is Russia’s need for hospices?

I think I'm not even 10% satisfied. There are 150 million people living in Russia, and about two hundred and twenty thousand are diagnosed with stage IV cancer every year. So calculate how many hospices are needed. Of course, we must take into account the cancer situation in a particular area. And for this we need honest medical statistics.

- Surely many readers will want to help the hospice in some way. What is the biggest need for hospice?

The hospice needs everything you need at home: books, audio and video tapes, and hygiene items. Our people live a normal life.

- Would you like to organize concerts for patients?

We constantly have concerts. But the staff needs them more. Sick people too, but less. As a rule, out of 30 patients, 8-12 people are present at the concert. We always welcome the arrival of artists and musicians.

- Vera Vasilyevna, the majority of Internet readers are young people. What would you like to wish to young people?

I always ask Irina Vasilyevna Siluyanova’s students, when was the last time they kissed their mother or hugged their grandmother? Everyone needs this. When leaving home, kiss and hug all your relatives; “and every time say goodbye forever...” Don't pass on evil. You were pushed into the subway - don’t be angry, forgive this man, he apparently has big trouble. Treat people the way you want them to treat you. You can work in a hospice, in children's institution, in the bank, but please remain human.

- Thank you.

Interviewed by Leonid Vinogradov

A terminally ill child... This tragedy can happen in the life of each of us, and then the main question arises: where to look for support when there is no more hope. The motto of the children's hospice "House with a lighthouse" is "It's not about death, it's about life". The hospice cares for children with incurable diseases, and it was their stories that formed the basis of a special project “ Time to live" on "D o mashnym". Premiere: April 8.

Mothers are often told by friends and doctors that they can’t cope alone when their dads leave them. Children are not accepted into kindergartens and schools, offering to “give birth to a second child.” And the worst thing is that young patients are not provided with qualified medical care; doctors give up on them and do nothing while the child suffers from pain. “ Home” will talk about hospice patients and their mothers, about doctors and people who devote themselves to helping children, and will also try to destroy myths about incurable diseases and how you can live with them.

Myth number one: “You can’t do it alone”

According to statistics, a third of fathers leave families with a disabled child and no longer participate in their lives. Young mother Daria Guseva has been raising Sashenka for three years. The child suffocated during childbirth and now lives with a diagnosis of ischemic damage to the central nervous system. The girl does not see, does not hear, does not move, but lives and breathes with the help of a tracheostomy and an oxygen concentrator. The father abandoned the family as soon as he learned about his daughter’s diagnosis and Daria’s decision not to send the child to a boarding school. But the mother says she is happy to be able to give her child the best.

Myth two "Incurable children do not need to be taught"

Of the 198 preschool children cared for by the House with a Lighthouse Children's Hospice, only 24 children are now going to kindergarten. Only 50 out of 155 schoolchildren are studying. One young man out of several dozen managed to enter the university. In our country they don’t understand why a terminally ill child needs to study, but hospice children dream of going to school. Artem Komarov is nine years old, but he is in second grade. He has congenital muscular dystrophy - the boy cannot even sit on his own, his arms are very weak. But in an electric wheelchair purchased by the hospice, he goes to an ordinary school in the city of Dubna in the Moscow region, whose director wanted to take the boy, despite a lot of problems with installing lifts and ramps. The hospice workers helped Artem make his dream come true and were able to negotiate with the school, which accepted Artem, despite his diagnosis.

Myth three “If you can’t cure it, it means you can’t help”

Little Fedya Raspopov died quietly in an orphanage. His medical history included a huge number of diagnoses and the staff did not understand how to care for him. One day, a hospice field service was invited to an orphanage to train nannies. Thus began an amazing story. Successful businesswoman Tatyana Konova responded to a hospice ad on Facebook to bring Fedya a toy. She fell in love and took him in and became a foster mother. Unfortunately, the boy cannot be cured. But how striking is the contrast between his life in an orphanage without special care - and at home, with his mother, with the support of a hospice.

Myth four “Hospice is when nothing can be done”

Thirteen-year-old, smiling, tall and handsome Maxim Bezugly was playing football with his friends. A jump, another, hung on the gate - they swayed under the weight and fell. The top bar struck the head, breaking the bones of the skull. Doctors said that the injury was not compatible with life, that he would always be on a ventilator. The tragedy divided everything into “ up to" And " after ". There was a lot, but now Maxim is home. Breathes and eats on its own. Every day his parents do something that makes Max feel better.

The chief doctor of the hospice, Natalya Savva, talks about how quality care prolongs the lives of children and brings joy back to them.

Myth fifth "If death is inevitable, nothing can be done"

In December 2016, mother Elena buried her daughter Pelageya, who was under the care of a hospice. She had a congenital genetic disease and spent nine months in hospitals and intensive care units. The girl's heart stopped. Now Elena admits that during these 9 months only hospice workers were with her. They helped her accept the inevitable.

Life is always stronger than death, even if the smallest and most defenseless are standing at the line. “ Homemade” I am sure: even if there is almost no strength and faith left - “Time to live”!

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A fragile figurine of a teenage girl. On pale face are burning brown eyes. A cigarette smolders in thin fingers with a bright manicure. There are beautiful pullovers and a miniskirt on the back of the chair, and a set of cosmetics in the nightstand. Natasha has just had a painkiller injection and is smiling again.

Diagnosis: stomach cancer. Fourth degree. The last stage of the disease, when doctors usually capitulate. As soon as death looms on the threshold, they look away: “Your cancer cannot be cured. Go." But there are no other patients at the First Moscow Hospice. The diagnosis is the same for everyone, with variations on a terrible theme. Breast, lungs, liver, brain, prostate - malignant tumor can develop anywhere and sprout its terrible sprouts anywhere. Of the twenty-six patients, only two are walking. During the short shift that I spent within these walls, two women died. There are days and nights when four people leave at once.

Nevertheless, no one would think of calling this beautiful mansion in the center of Moscow a house of death. On the contrary, terminally ill people who have gone through all the circles of cancer hell are returned here to a life in which there is no pain, anxiety and loneliness. Some are brought in in critical condition, with heavy bleeding, unabated pain, unimaginable swelling, terrible bedsores. Such patients, as a rule, are not admitted to ordinary clinical hospitals. Doctors there are focused on winning, and this category of patients is considered unpromising. They will never get better.

If in the West hospice is designed only for people living their last days, here some patients are observed for years. One patient had already been in bed 12 times. Those who cannot be removed are hospitalized pain syndrome at home, who are socially disadvantaged or whose relatives need temporary respite. One day there comes a time when the body gives up. The man can no longer fight, he protective forces are running out. And hospice means a decent life to the end.

There are currently five hospices in Moscow. This is 150 inpatient beds plus 600-700 patients who are under the care of the outreach service. Still, of course, it’s not enough.

Life with a red stripe

Most patients know their diagnosis because surgery, chemotherapy and radiation have left no doubt. But some end up in hospice directly from clinical hospital, where they were simply cut and sewn back up. Relatives are hesitant to tell them the truth and ask the staff to keep the secret. Such patients have a red stripe in their medical history - a sign to the doctor that the patient is not aware. Few people approach death philosophically. There are cases where an accurate prediction of the day of departure had a fatal effect.

When Natasha first received a referral to a hospice, she cried bitterly: was it really the end? And here I believed that I would live longer. Because doctors and nurses have already put her back on her feet six times. “I recently woke up at half past two in the morning and was terribly hungry,” she laughs. - I went to see my sisters, and they were so happy! They opened the refrigerator: “Now we’ll feed you!”

Correctly selected therapeutic complex, excellent care, good food, tender attitude, and illness seems to give a person a vacation. For how long? IN palliative medicine they speak cautiously: months rather than years, days rather than weeks. Sometimes we're talking about about the watch.

A choreographer by training, Natasha danced in the border troops ensemble at Far East. I was two years short of professional retirement. The disease began unnoticed. I was worried about nausea and, for some reason, back pain. She was treated for three years for a “stomach ulcer.” When the doctors finally diagnosed correct diagnosis, it was already late. The surgeon, having removed three quarters of her stomach and part of the pancreas, shook his head: “If only three years earlier!” Then "chemistry" and radiation therapy. Hair and teeth fell out, but Natasha did not lose heart. She managed to raise a good son, and together it is easier to withstand trouble. Natasha began to recover. But one day... The son did not return home; his body, or rather what was left of him, was found seven months later.

And the disease attacked redoubled force. Chemotherapy overdose. Coma. Natasha prepared to die. There was no reason to live... Her older sister came from Moscow to pick her up. Natasha vaguely remembers the flight Vladivostok - Moscow. She only started smiling at the hospice. The brave tin soldier is back in action.

We sit in the bathroom and smoke. At the hospice you are allowed to smoke even in bed. Smokers are housed together or in a separate room. When the patient is barely strong enough to hold a cigarette, one of the staff sits nearby and puts out the cigarette butts. The order here is absolutely amazing. Even in the famous “Kremlin” there is nothing like this. For example, there are simply no fixed visiting hours, because access to patients is open around the clock. Close people can live in the ward for some time if the patient’s days are numbered or he does not want to be left alone. By the way, even four-legged visitors are not prohibited from entering. Surprisingly, the animals immediately understand where they are and behave like well-mannered people. Even dogs are quiet. One orphaned cat disappeared for about a month, and then returned and began to “treat” the sick: she traveled from ward to ward and warmed the sickest ones with her warmth. Fish, turtles and birds often remain in hospice after the death of their owners.

The topic of euthanasia is never discussed here. Otherwise, the very existence of the hospice would be meaningless. Any doctor responding to a relative’s request to hasten death loved one will answer something like this: “Could you?” Anyone who is not suffering does not think about lethal injection. The Dutch and Belgians have already voted for euthanasia, and in Germany there are also increasingly voices in support of the last syringe. But this point of view cannot be considered in isolation from statistics. In the West, it has been calculated that in order to provide complete pain relief, doctors must prescribe 80 kilograms of morphine per million population per year. So, in Denmark they use 69 kg of morphine, in Germany - 18, and in the Netherlands only 10.

In Russia such statistics are not kept. However, according to World Organization healthcare, in Denmark, for example, 100 percent of patients are completely anesthetized, in the UK - 95, in the USA - 50, and here - only one percent!

Pain occurs when tumors irritate pain receptors in skin tissue, joints or nerve endings. Today there are enough means to save a person from unnecessary suffering. However, in reality, people are screaming in hellish torment, because the doctor has the right to prescribe a strictly defined amount of strong painkillers for exactly five days. Relatives are forced to save and calculate so that the dose is enough for the weekend and holidays when the drug is not available.

Fourth degree

...Galya lost her husband two months ago in a hospice. Cancer ate Evgeniy in less than three years. From strong blooming man, who weighed 102 kilograms before illness, remained a shadow. The scales showed only 47 kg. The diagnosis left no illusions: stomach cancer was in the last stage.

I torture her about the symptoms: did the disease really not manifest itself? No, she says, there were some discomfort such as burning, nausea, mild discomfort - not a cause for great concern. Moreover, a year before the diagnosis, my husband suffered abdominal surgery, then I was examined at a good clinic: ultrasound and gastroscopy, but nothing was found. But he was losing weight so quickly that his family became worried. Another doctor noticed something was wrong: “Urgently see an oncologist!”

They did not hide the diagnosis. They kept silent about only one thing: it was too late to operate. Galya rushed to call different clinics. "Oncology? - asked a confident voice. - We're treating! Fourth degree? Sorry".

Evgeniy was registered at the First Moscow Hospice, but he was in no hurry to go to bed. Field service employees came home and gave injections and bandages. And then the bleeding began, which could not be stopped at home.

He lived in the hospice for a little less than a month. The only walking patient at that time. It got so much better there that he even told his family: “If I feel like this, I’ll live until the summer!”

She remembers the last day minute by minute. At eight in the morning my husband called: “Don’t rush.” It was a frosty Sunday afternoon and the route had already become familiar. At twenty minutes to ten Galya entered the hospice. The door of the room was wide open, the doctors were doing something. The husband was still conscious, but he had exactly 67 minutes to live.

...First breakfast: ham, cream, semolina or rolled oats porridge, tea with lemon and coffee. Second breakfast: fruit juice, pear, orange, kiwi, yogurt, applesauce- to choose from. Lunch: two types of salad, pea soup or broth, marinated fish, mashed potatoes, peas and pineapple compote. For an afternoon snack, yogurt or mineral water. Dinner: squash caviar, green salad, roasted beef stroganoff or meat puree with side dish and tea. Before going to bed, serve kefir, fermented baked milk or milk with honey - if desired. This is the menu for one day.

As long as a person has an appetite, they try to pamper him. Some admit that they could only afford such food for a holiday. The dishes are tasty and varied, but the portions are small, because half a liter of soup, the prescribed amount, cannot be handled by a sick person. With cancer, people shrink before our eyes, the tumor consumes calories and grows. Eating often becomes a burden. Therefore, any gastronomic whim of the patient is immediately fulfilled. And they will fry potatoes, and they will bring herring, and they will run for vodka. The hospice knows: these patients only want something for fifteen minutes.

There are almost three staff members per patient. These are doctors, nurses, orderlies and volunteers who care for the sick free of charge. And yet the hospice is far from fully staffed. Despite the high salary, social benefits and pleasures such as a sauna with a swimming pool and a solarium. People here can't stand it for long.

Of those with whom I started exactly ten years ago, only six people remain,” says chief physician First Moscow Hospice Vera Vasilievna Millionshchikova. - Some people break down after a year and a half, others after three. Death, tears, grief are always nearby. This is not even extreme resuscitation, but much more difficult. Resuscitators pull a person from the other world and forget about him. And we have been closely communicating with the patient and his family for years, becoming close friends. These connections do not break for a long time.

Despite the staff shortage, getting a job here is not easy. Hospice sets the bar high. Sixty hours of unpaid service and three months probationary period- condition for candidates. Some people leave on their own, others are shown the door. The squeamish, callous and greedy have nothing to do here. The hospice has a system in place that eliminates the extortions common in hospitals. Everything is free here: medicine, massage, and care. Patients and their loved ones never have to feel humiliated.

Owl hour

With the doctor on duty, Olga Vyacheslavovna, we go on an evening round. She has been working here for five years now. At first I flew out as if on wings, enjoying the sun, the wind, and the smile of a random passerby. She learned to understand that all her troubles were nothing compared to this test of humanity.

Measurement blood pressure, easy inspection - everything is as usual. “You don’t have to endure the pain,” the doctor advises the patient with a face as white as a sheet, “immediately press the call button. The longer you endure, the harder it is to remove it.” Diagnosis: sarcoma, a malignant tumor of connective tissue.

In the next room we find a family in in full force. We came to visit my mother. A difficult sight. An artificially cheerful father, a grief-stricken grandmother, quiet children. “The pressure is excellent,” the doctor rejoices, “even to space!”

In a spacious room for four there are old women the same age. A beautiful round table, stylish armchairs, TV, refrigerator - the furnishings of a good hotel. The elderly patients were already patiently spoon-fed, everyone was given evening dressing, and diapers were changed. “Zoya Georgievna, sing! Do you remember the words? - a young nurse addresses a granny with a gray crest tied with a cheerful elastic band. “I remember,” the old woman agrees and begins the verse.

I can't go into the next room. Olya dies there. Mom and two closest friends are on duty at the bedside, replacing each other. Mom spent the whole day with her daughter, they tried to persuade her to go home.

Ole is only forty-seven. She has brain cancer and numerous metastases,” says Olga Vyacheslavovna. - Happened last summer epileptic seizure- this is how the disease was defined. During the examination they saw a tumor. I'm afraid she'll leave tonight. The pressure drops.

Olya will not be given Cordiamine injections to increase her blood pressure. For what? To prolong the decline for another day? The hospice does not have intensive care. No devices for artificial ventilation lungs, no defibrillators - everything that can delay dying. Here they don’t take blood ten times and don’t take X-rays.

In another ward with the same diagnosis lies Nina, a former neurologist. “Colleague,” the hospice staff sighs about the patient. This is not Nina’s first time in these walls. The disease has already taken away her speech and immobilized half of her body.

A couple of days ago I saw Nina. The nurses took the patient into the hall, which looked more like a winter garden, in which beautiful plants, a small waterfall gurgles and birds sing. “Ninochka, you look good today. How beautiful you are,” Vera Vasilyevna Millionshchikova admires and turns to me. “Isn’t it true that she is strikingly similar to the young Tatyana Samoilova?” Nina smiles at us with only her eyes.

People consider death to be the queen of the night, but this, of course, is not so. There is no so-called “night owl hour”. Patients leave at any time of the day. If this happens at night, relatives are informed only at seven o’clock in the morning. They subconsciously wait for this call. Almost everyone asks how it was. They are told that everything happened in a dream.

"Let her go..."

...The sheet of whatman paper is divided into two parts. On the left are the patients' names and their birthdays. On the right are the dates of death, the ninth and fortieth days. This is how it is done here. The connection does not break with the death of the patient. There are people who always stop by the hospice to visit the doctor or nurse. Some bring pickles and jam, embroidery, paintings, flowers. It happens that a person is unable to cross this threshold, then meetings take place on neutral territory. Mothers who have lost their children here never come. They just call.

The hospice accepts teenagers over 12 years old - the most difficult category for staff. Children are amazingly wise, they know everything about their illness and accept its conditions. They are rational and pragmatic. No arguments work on them, and even out of love for their mother they will not do more than they can. At first, young patients do not want to communicate with anyone. Every day, doctors and nurses look into such a patient’s room until he feels trust and sympathy for one of them.

The chief physician knows for sure: the nurse chosen by a sick child will not work in the hospice for a long time. First she sits at his bedside for hours, then she brings goodies and toys from home, then she visits him on her day off. The connection between these two becomes too strong. Death little patient becomes such a blow, after which severe depression sets in. First one and then the other sister admits that now they are unlikely to decide to become a mother, but after some time, of course, they do.

IN young body the cancer is literally raging. A person burns out in a matter of months. A man who just turned 32 recently passed away. Lena died the other day, she was only 34.

It seemed to us that she would leave on the day of admission. - Vera Vasilievna remembers all the patients by name. “She was hospitalized with confusion and in critical condition. And Lenochka lived for more than two weeks. Relatives hid the diagnosis from her, saying that it was osteoporosis, and she had breast cancer with metastases to all organs. The position of her relatives did not allow Lena to prepare for death; she clung very much to life. Relatives themselves want to be deceived, they are afraid to believe in trouble, and then they cry outside the door and hide their red eyes. They ask us not to say what kind of institution this is, although the staff wears badges with, in addition to the name, the inscription “First Moscow Hospice.”

Patients have their own hours. Many people wait for something, whether it’s spring or summer, and only then do they leave. People seem to be carrying out a given program. One patient said that she needed to live to see her daughter give birth and see her grandson. She actually looked at the baby and died that same night. Someone wants to wait for their anniversary, someone gives themselves the attitude: “I’ll die in three weeks” - and biological clock people are inexplicably ticking down to the appointed time. Sometimes it is completely impossible to explain from what source a person draws his strength. Here the mother dies, and the daughter cannot come to terms with it. She feels that she was not loved, not given enough attention, and begs: “Mommy, don’t die!” And mom takes a breath again. It happens that doctors in such cases ask: “Let her go!”

“Lord, I wish I could die,” a woman tormented by illness will sigh. “I’m tired of living, I’m tired of life,” her roommate will respond to her. “Let me leave quietly,” the third will ask. Nobody really wants to die. Neither the old people old age, neither the young, who, it would seem, have time to live and live, nor the young, who have not yet managed to do anything. But only the elderly leave more easily.

“They are ready to die,” Vera Vasilyevna says quietly. - The body is wise, and the disease is also wise. She treats the patient sparingly and does not force him to do more than he can. A person fights only as long as he can. Refusal to eat is a sure sign that the patient has no more than a week left. He is already falling into a semi-conscious state and looks beyond the distant horizons.

Sometimes people manage to apologize to someone, thank someone, or make important orders in their last days. A husband confesses his love to his wife after half a century of marriage.

The priest Father Christopher comes to the hospice every Tuesday, confesses, administers unction, and administers communion. On major holidays the liturgy is served. In ten years there were three or four baptisms and one wedding. In a small chapel, the famous playwright married his wife.

But the farewell scenes, which are so heartfeltly described in novels or played in films, real life occur extremely rarely. No one knows for sure who gives the signal for death, who turns off the light of life. The person weakens, breathing becomes shallow, the mind goes blank. Death comes unnoticed. People leave peacefully. There was, however, a patient with a very difficult character who fought fiercely for her life. She died in anger, having managed to whisper to her mother sitting at her bedside that she was cursing her. Such cases are rare.

Seifulla, a short, stocky man with a blush from walking, unlike other hospice residents, does not look terminally ill. “I still have muscles in my legs,” he smiles and shows me his strong white calves. And then he takes out the clinic outpatient card, where it is written in black and white: “Prostate cancer and multiple bone metastases.” He lived a decent life and raised wonderful sons. He loved sports, went to the pool, studied according to Nikitin’s method. Where did this disease come from?

Was it not when Seifullah’s soldier served in the navy and was on duty at a signal and observation post under radar antennas emitting currents? high frequency? Or when he, like all students in Uzbekistan, worked harvesting cotton treated with toxic herbicides?

Why is this happening? There is no clear answer. How does a girl with unformed breasts get breast cancer? How to explain the “dandelion effect” in melanoma, which, as soon as you touch it, scatters throughout the body with dozens of metastases? Or casuistic cases when a person has many metastases, but for some reason the tumor that gave rise to them is not found. Oncologists are sure of one thing: there are no miracles in this matter. Only mistakes in diagnosis happen.

He was given various diagnoses from osteochondrosis to pyelonephritis, and time worked against Seifulla, because there was less and less of him. He is an obedient patient and follows all the doctors’ orders, but the cancer stubbornly takes away his strength, and Seifulla does not want to live to see the day when he becomes helpless and turns into a burden for his family.